Provider Demographics
NPI:1518082684
Name:SOUTHEAST OB-GYN ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHEAST OB-GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-333-0532
Mailing Address - Street 1:4115 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3729
Mailing Address - Country:US
Mailing Address - Phone:210-333-0532
Mailing Address - Fax:210-333-2292
Practice Address - Street 1:4115 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3729
Practice Address - Country:US
Practice Address - Phone:210-333-0532
Practice Address - Fax:210-333-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098135902Medicaid
TX080320701Medicaid
TX150344301Medicaid
TX150344301Medicaid
TX82932KMedicare ID - Type UnspecifiedDR. MARGARET A. KELLEY
TXC17775Medicare UPIN
TXH56954Medicare UPIN